Oral antibiotics with MBP reduces risk of SSI in colorectal resection

The rate of surgical site infections was 27% with mechanical bowel preparation only, and 8% with oral antibiotics combined with mechanical bowel preparation

Combining oral antibiotics with mechanical bowel preparation (MBP) is associated with a significant reduced rate of surgical site infections (SSIs) for patients undergoing elective left colon and rectal cancer resections, according to a study published in JAMA Surgery. Researchers from Baylor College of Medicine in Houston, TX, found that oral antibiotics, MBP and minimally invasive surgery were independently associated with reduced odds of SSIs, and the rate of surgical site infections was 27% with mechanical bowel preparation only, and 8% with oral antibiotics combined with mechanical bowel preparation.

In the study, ‘Association of the Addition of Oral Antibiotics to Mechanical Bowel Preparation for Left Colon and Rectal Cancer Resections With Reduction of Surgical Site Infections,’ the investigators sought to determine the association of the addition of oral antibiotics to MBP with preventing SSIs in left colon and rectal cancer resections and its association with the timely administration of adjuvant therapy.

They performed a retrospective review of 89 patients undergoing left colon and rectal cancer resections from October 2013, to December 2016. Patients receiving MBP and oral antibiotics and those undergoing MBP without oral antibiotics were compared using univariate analysis. The primary outcomes measure was SSI within 30 days of the index procedure and time to adjuvant therapy.

Of the 89 patients (male=84) in the study, 49 underwent surgery with MBP but without oral antibiotics and 40 underwent surgery with MBP and oral antibiotics. The surgical approach (minimally invasive vs open) and case type were similar but the median operative time of patients who received oral antibiotics and MBP was longer than that of patients who received MBP only (391 minutes vs 348 minutes, p=0.03).

The overall SSI rate was lower for patients who received oral antibiotics and MBP than for patients who received MBP only (3 [8%] vs 13 [27%]; p=0.03), with no deep or organ space SSIs or anastomotic leaks in patients who received oral antibiotics and MBP compared with 9 organ space SSIs (18%; p=0.004) and five anastomotic leaks (10%; p=0.06) in patients who received MBP only.

However, there was no difference in median days to adjuvant therapy between the two cohorts (60 days for patients who received MBP only vs 72 for patients who received oral antibiotics and MBP; p=0.13). Oral antibiotics and MBP (p=0.04) and minimally invasive surgery (p=0.03) were independently associated with reduced odds of SSIs.

"The combination of oral antibiotics and MBP is associated with a significant decrease in the rate of SSIs and should be considered for patients undergoing elective left colon and rectal cancer resections," the authors conclude.

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